Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00221
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S114DB00100
Jurisdiction:
Site address: 17005 SW 92ND AVE
Project: Cook Park Shelter & Bathroom Subdivision: Lot:
Project Description: 100 amp feeder for new pre -fab restroom.
Contractor: MOUNTAIN F ENTERPRISES INC Owner: TIGARD, CITY OF
25973 S MOEHNKE LN 13125 SW HALL BLVD
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503 - 313 -0761 PHONE:
FAX: 503 -632 -5521
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/27/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/27/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ac^rrd_^'e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • NTION: Orego law - .uir-s you to follow the rules adopted by the Oregon Utilit ■ • " - on Center. Those rules are set forth in OAR
952 -0r 1 -0010 through OAR 95 :01-0I You may obtain a copy of the rules or direct questions to 0 • by c- 87 or 1.800.3 , .2344.
Issu• . By: � Permittee Sig ��_ /_, 112, '• 1 / _�.. � •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
04/27/2011 15:37 503-632-5521 ALAN FITCH ELECTRIC PAGE 02/02
Electrical Permit Avolicati 1-(11Z ili- Hi' l 1 •;1 (0.1, \
City of Tigard
13125 SW Hall Blvd., Tigard, OR 07A13 p il 7 2011 Plan Review
Phone: 503.639.4171 Fax: 503.59839SO
Inspection line: 503.639.4175 h
Internet: wwwgard CITY OF TIGARD Received A 4 47 ,I7A Perri:414o
Date/B :
Amen) ;
TiotifierVMethod: __
Other Permit:
Date Ready/fty: NOM ler
RI S ee P age 2
9upprementat information
,,,i PI 6 46 $2 4 1110 g . . ..., . . ot ' : i'....;4 ^ 4 ..:. :ts• .P.
t etNew constructiort El Arklition/alteration/replocernent Please check all that apply (submit 2 sets of plans w/items checked below);
0 Service or feeder 400 amps or more 0 Building over three stories.
CI Demolition El Other: where the available fault current El Marinas and boatyards.
''..: , ,',roji4iik04 : ,,,. i , , ,,..; . ;l.: 0Xce0dS 1000 amps at ISO volts or C] Floating bnildings.
• ' " " , . ,
less to ground, or exceeds 14,000 0 Conuntrcial egrioulterai
0 1- and 2-family dwelling it Commercial/industrial 0 Accessory building corms for all other installations, buildings.
LI Multi-family CI Master builder CI Other: 0 Fire pump. El Installation of 75 TCVA or
tI 4i si ft:e4tioitiviiiiiiiiii:iki..ibialito,,.: ; :, ..;:,..,..:,,!:>;: .,,,,„, ,:, 0 Emmaency system. larger separately derived system. LI Mdstion of flew motor load of LI
a l , t I N_ A iO43-17 ac more. occupancy.
Job no.: Job site address: 111:2D5 SO - e, r--vVri,-, 0 Six or nnore residential nines, 0 Recreational vehicle packs.
Cit ■.6-0 Olt. 0 Health-care facilities. 0 Supply voltage for more than
. .. . 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: Cionr_S PA g ir, 0 Service ot feeder 600 mops or more.
1L; ,.:7
Cross street/directions to job site: xneenneee I O. I Fee'. i rood, '_,t *.
New residential single or multi-family dwelling unit.
Includes attacked garage.
Subdivision: Lot no.: 1,000 sxl. ft. or less .,, ._, 168.54 4
Ea. add'i 500 sq. ft. or portion ' 33.92 1
Tax map/parcel no.: Limited energy . , residential ...
67.84 2
'',;. ''''..;''';',."."';',".,''.',..:''' :'...',':•;';'.4,.!.,..:': j0V.:Saiiiirif i ;:iiii8iitit (!_uids above sq. 0.). .. ...
Limited energy, multi
( DO 4M F0*AL- l'it- Pi DOS Attr 45tiok residential (with above sq. 11.) 67.84
2
Services or feeders installatio . iilteration, and/or relocation
, , , , 200 amps or less / 100.70 /DP, 7C? 2
l n ';.'Siiiitilliti ii*Ni0 :;:>'''',' :.'. ''..: ';': .: ,:'.13:'***0 201 amps to 400 snips 133.56 2
Name; 401 amps to 600 amps 200.34 2
. ... 601 amps to 1,000 amps 301.04 2
Address: Over 4000 amps or volts 552.26 2
.. _
City/Statc/ZIP: Temporary services or feeders Installation alteration, and/or
relocation
Phone: ( ) I Fax: ( ) - 200 amps or less.
a X wl 5.36 1
, . . . .
Owner installation! This installation is being made on property that I own which is not 201 amps to 400 snips 125 . 08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 ' 2 2
Branch circuits new, alteration, or extension, t panel _ ,
Owner signature:. Date: A. Fee for branch circuits with
,PO:jeAiNit'',:':i:/ .,':', :'': '''' ;' ' ' 4 : ':'' ' '': ' :I:.1' : :' .', t04:160):051,41: ''.' '', ''. '': ';', above service or feeder fee,
742 2
each branch circuit
Business name: R. Fee for branch circuits
without service or feeder fee,
Contact name: 56.18 2
first branch circuit
Address: Each add'i branch circuit 7.42 2
- ... , .
Miscellaneous (service or keder not Included)
City/State/ZIP: Each manufactured or modular'
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
I" .: " '' ,'",'.;' ' . • "'"7:•:' ' ..'..• ' ..'. '...'"' Y‘: ..'.';:''' '') :.'. :.:' ' ' ,,•' r'';'.:' Sign or outline lighting 67,84 2
Signal circuit(s) or limited-
Business name: lit v F i1/471; . T.4 tersitt. Attftiers) Fri
Address: t-AA 7l.iie. , energy panel, alteration, or
extension. Describe: Page 2 2
7seil..5 s , in p to y,ii, (..
city/stateiziP: - ?-6\t 4 L.cie.,,ti,kr Ot 011-0P44 Each additional ins ection over allowable in an of the above
Per inspection 66.25
Phono: (-1 -P., & k 1 Fax: ( %,,_- S2..1 Investigation i 4 hour (I hernia) 66.25
CCB Lie.; \.' \ Ct Electrical Lic.: 2 D -72 a- c I Suprv. Lic.: "SI-2A 5 Inclustri a1 . taut .crlinur .s, 78.i8
..,....., .
suprv. Electrician signature, required: Siltotg tE)0,
Plan review (25% of permit fee):
;T F \ --, s -O r _N c Date: -z_- _ I t . .
State surcharg,c (12% of permit fcc); tr'a ,(3 g
. . .
Authorized signature: TOTAL PERMIT FEE: ) I. i.rfi 13
P r int name; 27*CINA ( Date: This permit application expirealf a permit is not obtained within ISO
days after It has been accepted as complete.
--,- —
• Number of inspections allowed per permit.
IA/kidding \Permits\ ELC-PermitApp.doc tO1OI8D9 440-4611TO 3/05/COMAVER